Family Nurse Practitioner Exam

In a child with type 1 diabetes, what is the best adjustment to manage high afternoon blood sugar levels?

1. Increase both types of insulin in the morning

2. Decrease the afternoon NPH dose

3. Focus on modulating the evening NPH dose

4. Switch to long-acting insulin exclusively

The correct answer is: Increase both types of insulin in the morning

In the management of type 1 diabetes, achieving stable blood glucose levels throughout the day often requires careful adjustments to insulin therapy. A child experiencing high afternoon blood sugar levels may indicate that the morning basal and bolus insulin doses are not adequately covering their glucose needs, particularly as the day progresses. Increasing both types of insulin in the morning can provide a more robust correction for high blood sugar levels in the afternoon. The rationale behind this adjustment lies in the pharmacokinetics of insulin: administering an increased morning dose enhances basal insulin coverage during the active hours of the day and improves postprandial glycemic control, which is crucial given the child's dietary intake and activity levels. Other options involve adjustments that may not directly address the problem of elevated afternoon blood sugar. Reducing the afternoon NPH dose or focusing on the evening NPH dose may not effectively counteract the high blood glucose levels experienced earlier in the day. Switching to long-acting insulin exclusively could also limit flexibility and the ability to fine-tune dosing throughout different times of the day, particularly for a child whose insulin needs may fluctuate based on their activity and food intake. Therefore, increasing morning insulin dosages is a proactive approach to ensure that insulin is available when the child is likely to have higher